Provider Demographics
NPI:1588706360
Name:RODRIGUEZ, LAZ D (DC)
Entity type:Individual
Prefix:DR
First Name:LAZ
Middle Name:D
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4600 NW 107 AVENUE
Mailing Address - Street 2:SUITE 2408
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-7070
Mailing Address - Country:US
Mailing Address - Phone:786-999-2514
Mailing Address - Fax:305-817-2681
Practice Address - Street 1:4600 NW 107 AVENUE
Practice Address - Street 2:SUITE 2408
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-7070
Practice Address - Country:US
Practice Address - Phone:786-999-2514
Practice Address - Fax:305-817-2681
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4496111N00000X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NX0800XChiropractic ProvidersChiropractorOrthopedic